Saturday, June 25, 2016

Rupture in Large Kista Endometriosis Cyst

Rupture of the endometriotic cysts can occur any time of the cycle during the menstrual flow. Kista endometriosis is a common disease in women, the incidence varying from 10 to 50 percent in different parts of the world. Acute abdomen pain results from rupture of ovarian kista endometriosis cysts. Other symptoms are fever, vaginal bleeding. The pain was sudden, severe and continuous.

Cases of acute ovarian kista endometriosis cyst rupture are rare, but they may be associated with severe peritonitis and systemic disturbance, followed by adhesion formation. A theory on the formation of ascites in endometriosis was postulated by Bernstein, who suggested that the blood and endometrial cells shed into the peritoneal cavity may irritate and stimulate the peritoneum, thereby resulting in ascites. Other authors have reported that rupture of endometriotic cysts with subsequent peritoneal irritation and the production of reactive exudates may provide an explanation. Ruptured endometriotic cysts sometimes present a diagnostic problem and surgical challenge because patients with a ruptured cyst present with symptoms of an acute abdomen associated with severe abdominal pain and unstable vital signs. Ruptured ovarian endometriotic cysts can sometimes mimic ovarian malignancy because of the extremely elevated serum CA 125 concentration.

Emergency surgical intervention may lead to a better prognosis, particularly in patients without a history of previous endometrioma surgery.

In patients with ruptured kista endometriosis cysts, the ascites is usually confined to the pelvic cavity with a loculated contour, and this suggests associated pelvic adhesion, which is an extremely common and important complication of endometriosis. After a corpus luteal cyst ruptures, hemoperitoneum will be present within the pelvis and possibly throughout the abdomen. Higher attenuation blood is typically present within the pelvis, as compared with being present the abdomen, and blood may be present adjacent to the cystic lesion, indicating that the source of the hemoperitoneum is cyst rupture.

A Corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation, and take up to three months to disappear entirely. A corpus luteum cyst rarely occurs at age 50+, because eggs are no longer being produced in menopausal women. Corpus luteum cysts may contain blood and other fluids. The physical shape of a corpus luteum cyst may appear as an enlargement of the ovary itself, rather than a distinct mass -like growth on the surface of the ovary.

The CT appearance of ruptured endometriotic cysts is relatively distinctive compared to that of ruptured functional cysts, and the accurate preoperative characterization of ovarian cyst via CT will help the surgical planning. In conclusion, the diagnosis of ruptured endometriotic cyst should be suspected for a woman in whom CT reveals the presence of multilocular or bilateral ovarian cysts with a thick wall and loculated ascites confined to pelvic cavity with pelvic fat infiltrations.

This video shows how Dr Vijay removes a ruptured kista endometriosis cyst using laparascopy.

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